Individual
DR. DICK WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
210 SERIO BLVD, FERRIDAY, LA 71334-2015
(318) 757-3440
(318) 757-3446
Mailing address
210 SERIO BLVD, FERRIDAY, LA 71334-2015
(318) 757-3440
(318) 757-3446
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1060-169T
LA
152W00000X
Optometrist
Primary
564
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087047
—
MS
01
—
0133910002
MEDICARE PALMETTO
—
05
—
1388734
—
LA
01
—
2302B
BLUE CROSS OF LA
LA
01
—
721149589
TENET CHOICES HUMANA
—
Enumeration date
10/23/2006
Last updated
06/17/2020
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